The conversation started as a check-in with the Wyoming Department of Health on its Medicaid developmental disability waiver program, also known as “DD waivers.”
The program acts as a social safety net for Medicaid-qualifying state residents who have intellectual disabilities or brain injuries.
The director of the Health Department, Stefan Johansson, testified at the meeting of the interim Joint Appropriations Committee on Aug. 20 that lawmakers could choose to fully fund those on the wait list for the program, raise payment rates for providers or tinker with funding for recipients of the program who need emergency care, or all of the above.
“You'll recall that last time we spoke … I expressed my interest and support in the DD waiver program,” said Rep. Ken Pendergraft (R-Sheridan), a member of the Wyoming Freedom Caucus. “I think it's a valuable thing to do. I made what might be kind of an unusual request of you, to have a little bit of introspection to your agency and see if there might be some sacrifices that you as an agency could make. So my question is, are we going to see, in your proposed budget coming up, any reflection of that?”
Johansson replied that he respected Pendergraft’s intention.
“I think that's absolutely possible, but at this scale, keep in mind this program right now in our Department of Health budget is over $300 million on the biennium. It's a large-scale, very expensive program, because these services and the acuity of some of these clients is very high,” said Johansson.
The committee didn’t take action on adding or removing funding to the DD waiver program or on any other matter in general. But towards the end of the meeting, Pendergraft spoke up again, this time with a motion to form a three-member subcommittee under the Appropriations Committee that would conduct an “investigation and analysis” of the Health Department’s budget.
“Whereas the Wyoming Department of Health has a larger total budget, about two and a quarter billion, than any other agency other than K-12,” he said. “Although the Department of Health's general fund budget has grown modestly, approximately $30 million in the last decade, the agency has benefited from considerable one-time federal funding during the pandemic. Whereas even modest percentage increases to such a large agency’s budget can have significant impact on total state budget needs, the Department of Health's budget has an outsized impact on Wyoming's total budget.”
He ended his motion by saying “aggressive legislative oversight and attention is warranted.”
In a voice vote, the majority of the committee agreed with him. Funding for the subcommittee needs to be approved by the state Legislature’s top leaders in the Management Council.
Committee co-chair Rep. John Bear (R-Gillette), who’s also a member of the Freedom Caucus, said, if approved, the subcommittee would embark on a fact-finding mission and search for “efficiencies” within the Health Department budget, similar to the federal Department of Government Efficiency, or DOGE.
“I think if you're looking for efficiency, yes, we are, and that's what DOGE stands for, Department of Government Efficiency,” Bear said in a phone interview. “So yeah, we're looking for efficiency. We're looking for opportunities to make sure that we're funding the right things at the right level.”
A spokesperson for the Health Department did not respond to requests for comment about the subcommittee.
Bear gave an example of one funding area he thought should be reduced.
“ For instance – and I believe it's mostly funded by federal funds, but we approve those funds for the department – an advertising program for ensuring that children are vaccinated,” he said. “It is directed at children. I think parents really should be the ones determining what kind of vaccinations their children take. So to have an advertising program directed at children, I think, is neither wise nor in line with the Legislature's intent to make sure that parents have the priority on decision making for the children.”
Others on the committee said the move to establish a Health Department “DOGE” panel was ironic, since it could wind up costing taxpayers thousands for its two in-person meetings if it winds up being approved.
“ For a bunch of people that say they're conservative, they sure do like spending money on road trips,” said Sen. Mike Gierau (D-Jackson). Gierau said that if the main intent of the subcommittee was to learn more about the inner workings of the Health Department, members of the Freedom Caucus could accomplish that by meeting with agency heads in-person “on their own dime” or over Zoom.
But Gierau said he heard the overall purpose of the subcommittee might be different than that.
“ What I heard when it was discussed was that it was a DOGE committee,” he said. “[I heard] that they're gonna take a big whack [to the budget]. I got a feeling they're going to find out, when given the facts, that the Department of Health does a lot of really important things.”
He cited the DD waiver program, fighting “the scourge of teen suicide” and helping those on Medicaid as examples.
For his part, Bear said that if the subcommittee ends up cutting costs in the Health Department, it could more than make up for its own price tag.
“ I think a few thousand dollars that could lead to tens of thousands, if not hundreds of thousands, if not millions of dollars in savings is probably a good investment for the people,” he said. “This is where over $2 billion is placed into our budget. It's one of the largest portions of our budget. So to do a deeper dive can help us ensure that we're not creating unintended consequences, should we make some considerable cuts in that department.”
Rep. Trey Sherwood (D-Laramie) said she viewed the subcommittee as an opportunity for lawmakers to see how federal cuts to states might trickle down to the Health Department.
“ What's really been on my mind is, how will reductions from this current administration at the federal level impact the programs offered by the Department of Health?” said Sherwood. “Because so many of them are 50% state, 50% federal. If the feds pull their 50%, then the question becomes, ‘Can the state backfill that program, or does that program go away because we may not have the resources to keep it going without the federal match?’”
If it’s greenlit, the Department of Health Subcommittee would join three other recently-formed subcommittees: the Management Council’s Subcommittee on Legislator E-mail Policy, the Joint Corporations, Elections and Political Subdivision’s Subcommittee on Reapportionment, and the Management Audit Committee’s Subcommittee on Weston County election errors.
This reporting was made possible by a grant from the Corporation For Public Broadcasting, supporting state government coverage in the state. Wyoming Public Media and Jackson Hole Community Radio are partnering to cover state issues both on air and online.
